UPDATED | Where You Can Buy Health Insurance After Today

Amy Payne /
March 31, 2014

UPDATE (April 2): We wrote on March 31 (below) that Americans would still be able to buy health insurance in the individual market—outside Obamacare’s exchanges—after the Obamacare deadline. The Associated Press reported the same thing on April 1:

Buyers can always go directly to an insurance company, but it may be expensive. Plans bought outside the marketplaces don’t come with government subsidies that hold down the cost for people with low or mid-level incomes. But they do include the law’s consumer protections. For example, insurers can’t turn down customers because of pre-existing medical conditions.

Even after the deadline, buying a plan that meets the law’s essential coverage standard reduces the penalty owed, which is based on the number of months without coverage.

When the law was passed, Obamacare indicated that insurance companies offering coverage in the individual market would have the leeway to determine their own enrollment periods, if desired. But now that the open enrollment period has closed for the Obamacare exchanges, it appears that in most states, so has enrollment in the individual market.

Our staff visited eHealthInsurance.com, where individual policies are usually available, testing one ZIP code for every state. For all but two states, we received this message: “Now that the Open Enrollment Period (OEP) has ended, you’ll need to experience a qualifying life event to enroll in a qualified health insurance plan.” (Qualifying life events include marriage, loss of a job, and the birth of a child, for example.)

In these early days of April, Oregon and Nevada were the two states where policies were still available for purchase. We know that the Oregon Obamacare exchange extended its signup deadline to April 30 because of its own website woes.

It makes sense for insurers to follow the same enrollment period as Obamacare, because one of the law’s mandates is that insurers must issue a policy to anyone at any time, regardless of pre-existing conditions. Observing a set enrollment period makes it more difficult for people to wait until they are sick to buy coverage.

Note: People who are eligible for Medicaid and the Children’s Health Insurance Program (CHIP) can apply for those programs year-round.

When we wrote about the Obamacare deadline and penalty recently, a reader brought up a great question: Can you still buy health insurance after March 31?

She asked, “If I chose to go uninsured, but end up with a massive medical issue,” could she “just buy insurance and be covered, you know, since they must cover pre-existing conditions”?

The answer is yes. If you don’t have Obamacare-compliant health insurance by today, you could pay the penalty for this year—depending on the amount of flexibility the administration decides to offer in its latest delay—or you could still purchase a policy anytime in the individual market outside the Obamacare exchanges. The amount of time you go without coverage determines your penalty—or as the IRS calls it, your “shared responsibility payment.”

Under Obamacare, the new pre-existing conditions rule means that you can wait until you develop a health problem to get your policy. This isn’t great for the system, because healthy people’s premiums are needed to pay for the sick people. So if fewer healthy people buy health insurance, the system has a problem.

That’s why the Obamacare system has a mandate forcing everyone to buy insurance, a (somewhat) set enrollment period, and a financial penalty to back it up.

If you don’t already have employer-sponsored insurance or coverage through a government health program, your options are the Obamacare exchange or the individual marketplace. Policies in both have to comply with all of Obamacare’s rules and benefit mandates, so the big difference is the taxpayer-funded subsidies.

The subsidies are supposed to be the big draw of the Obamacare exchanges—but it turns out they aren’t as simple as they seem. And holding onto a subsidy can encourage people to stay stagnant in a job—or worse, not seek employment. As Heritage experts have explained and the Congressional Budget Office has confirmed, “The law gives millions of Americans new incentives not to work—or not to raise their income levels—because they may lose federal insurance subsidies.”

Today’s deadline marks the end of the open enrollment period to buy subsidized coverage in the exchange. Enrollment for subsidized coverage doesn’t officially start again until November 15 of this year.

Whether it’s your state or the federal government running your nearest Obamacare exchange, the goal remains the same. Heritage experts Robert Moffit and Ed Haislmaier described the transition from the old individual market to “private coverage in name only”:

The primary goal of the Obamacare exchanges is to establish federal control over state health insurance markets by enforcing new federal insurance rules and requiring federal standardization of health benefits.

And policies in the remaining individual market must, by law, look exactly the same. You can buy them anytime, but the benefit design isn’t likely to be much different. (Just watch how long you go without coverage, or the penalty for being uninsured will kick in.) Obamacare doesn’t improve on the old health insurance market—which is why we need patient-centered reforms that give people more choice.